Levels of health coverage determine the extent to which people are protected from the financial consequences of ill health (financial protection) and have access to needed services. When public resources for health care are limited, policy makers may try to relieve financial pressure by reducing coverage. Coverage has three dimensions:

  • the population covered: 'breadth' or universality
  • the range of services covered: the 'scope' of the benefits package
  • the share of service cost covered: 'depth', whether or not people have to pay user charges for covered services.

By reducing any aspect of publicly financed coverage policy makers are effectively shifting costs to individuals. This creates opportunities for private finance in the form of out-of-pocket payments (including user charges) and voluntary (private) health insurance. Key issues include the extent to which increased reliance on private finance relieves rather than exacerbates financial pressure; strengthens rather than undermines health system performance; and enhances or at least does not lower efficiency in the allocation and use of public resources.

Many of the countries in Europe reported reductions in coverage during the crisis (Mladovsky et al. 2012). Reductions were generally at the margin, mainly affected coverage scope (benefits) and depth (user charges) and were often accompanied by efforts to protect poorer people from higher user charges.



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